Senior Revenue Integrity Analyst

Luminis Health

Title:

Senior Revenue Integrity Specialist

Department:
Revenue Integrity

Reports To:

Director, Revenue Integrity

Cost Center/Job Code:

-003004

FLSA Status:
Exempt

The Revenue Integrity Coding Specialist works in the Luminis Health Revenue Integrity department and serves as the key liaison and subject matter expert on all aspects of hospital charge capture and entry, charge integrity and charge reconciliation processes. This position will support and coordinate on‑going charge capture and integrity improvement initiatives including charge reconciliation activities, new service implementation, third party payer audits, CDM audits, and identification of revenue management opportunities.

They will align with clinical leadership and serve as the subject matter expert regarding billing compliance, accuracy of charge capture and integrity processes including education, audit activities, changes or risk of revenue (regulatory or coding changes) and monitoring of charge capture related metrics to minimize revenue leakage.

• Manages and tracks all hospital 3rd party payer audits; performs defense audits and educates clinical departments on lost payment opportunities
• Performs internal review of Revenue Cycle processes
• Collects, disseminates and educates clinical departments on all state and federal billing/coding/charging updates
• Provides charge capture education to clinical departments
• Performs CDM audits in accordance with Luminis Health Chargemaster Review Policy
• Proficient Use of Support Systems
• Efficient utilization of billing system database to update, Charge Description Master (CDM); ensures broad understanding of all areas of revenue cycle including pre-AR, actualized AR review and router logic
• Ability to appropriately edit charges via Charge Router and document actions via notes in the Resolute billing system.
• Demonstrated ability to utilize Outlook email and navigate in the Word and Excel software applications.
• Competence in Coding, Billing and Charge Integrity Workflows
• Evaluates current charging and coding structures in clinical, coding and Revenue Cycle departments to ensure appropriate capture and reporting of revenue and compliance with state/federal government and third‑party payer requirements
• Assess the accuracy and build of all Charge Capture related workflows in EPIC, including documentation, automation enhancements
• Demonstrates the ability to understand and utilize payer rejections and remittance denials to execute denial management strategies in an effort to mitigate the risk of future denials.
• Organizational Efficiency
• Effectively maintains audit and account activity by ensuring the proper organization, tracking, filing and documenting of all correspondence.
• Assists in proactive communication and root cause analysis of challenges impacting final adjudication of claims, including but not limited to system or payer issues
• Provides Outstanding Customer Service
• Creates a cross‑collaborate approach with, billing teams, Coding, HIM and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation and compliant billing of all charges.

• BS in Finance, Accounting or Healthcare related field preferred
• In lieu of BS degree, 10 years of hospital Revenue Cycle/Revenue Integrity experience preferred
• 5-7 years experience supporting Revenue Cycle and Clinical systems
• Works well in environment with firm deadlines; results oriented
• Demonstrates strong knowledge of end to end revenue cycle
• Experience in EPIC required
• Experience with Microsoft Office, Word and Excel
• Ability to communicate professionally via internet and virtual communication tools

• Coding certification required (CPMA, CPC, CBCS or CCS)

There is a reasonable expectation that employees in this position will not be exposed to blood‑borne pathogens.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The physical demands and work environment that have been described are representative of…